Provider Demographics
NPI:1437963618
Name:METZ, MELLISA
Entity type:Individual
Prefix:
First Name:MELLISA
Middle Name:
Last Name:METZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 MIDDLE RUN RD NW
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-7655
Mailing Address - Country:US
Mailing Address - Phone:330-316-5287
Mailing Address - Fax:
Practice Address - Street 1:5916 MIDDLE RUN RD NW
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-7655
Practice Address - Country:US
Practice Address - Phone:330-316-5287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator